Examining the associations between attention-deficit/hyperactivity disorder, sleep problems, and other mental health conditions in adolescents

Adolescents with attention-deficit/hyperactivity disorder (ADHD) often experience greater sleep difficulties compared to those without. However, findings are mixed, and other mental health conditions are often overlooked. This study aimed to examine the relationship between sleep problems, ADHD, and other mental health conditions in a sample of adolescents. Data from 373 adolescents aged 10–19 years was used as part of the wider ‘Healthy Brain Network’ study, which targets children and adolescents experiencing mental health and neurodevelopmental difficulties. Mental health conditions were assessed via a comprehensive assessment. Sleep was measured by self- and parent-report, as well as via up to a month of actigraphy data. Actigraphy data were analysed using mixed-methods modelling, while subjective sleep data were analysed using multiple regression. Subjectively-reported sleep was generally worse in adolescents who had ADHD and other mental health conditions compared to those with ADHD but no other conditions. There were no associations between ADHD status and objective sleep measures or self-reported measures, but a significant association was found between ADHD status and parent-reported sleep difficulties, even when accounting for other conditions. Parent-reported sleep problems were associated not only with ADHD, but also with anxiety, depression, and externalising disorders. The strength of association between ADHD and sleep problems is potentially not as strong as previously thought when considering the role of other mental health conditions. Clinicians should consider the role of other mental health conditions when sleep problems are present, and vice versa. The study also highlights the importance of comprehensive, multi-informant assessment of mental health conditions, including sleep.